This invention relates to a method and apparatus for diagnosing neurological conflicts in persons. The invention is especially adapted to diagnosing learning disabilities, but has application in diagnosing other neurological conflicts. The invention may also be used to prescribe corrective interventions for neurological conflicts.
Diagnostic criteria for various learning related disorders are contained in the volume of DSM IV diagnostic codes of the American Psychiatric Association. One such disorder is Attention Deficit Hyperactivity Disorder (ADHD). Questions are raised whether ADHD constitutes an actual syndrome in view of the variability of symptoms across settings and parameters which may affect this variability. Barkley, R. A., xe2x80x9cA Critique of Current Diagnostic Criteria for Attention Deficit Hyperactive Disorder: Clinical and Research Implications,xe2x80x9d J. Dev. Behav. Pediatr., 11(6): 343-52 (1990). ADHD is often present with other disorders, such as Oppositional Defiant Disorder (ODD). Conduct Disorder (CD), Dyslexia, Tourette Syndrome (TS), and the like. It is also known that ADHD may result from one or more disorders. For example, there is an excess prevalence of premorbid ADHD among children who are present with moderate and severe Closed Head Injury (CHI). Gerring, J. P., Brady, K. D. et al., xe2x80x9cPremorbid Prevalence of ADHD and Development of Secondary ADHD After Closed Head Injury,xe2x80x9d J. Am. Acad. Child. Adolesc. Psychiatrv, 37(6): 647-54 (1998). Children born to mothers who had abused alcohol throughout pregnancy also produces ADHD along with other intellectual problems. Aronson, M. B., Hagberg et al., xe2x80x9cAttention Deficits and Autistic Spectrum Problems in Children Exposed to Alcohol During Gestation: A Follow-up Study,xe2x80x9d Dev. Med. Child Neurol., 39(9): 583-7 (1997).
It is imperative that a child with a neurological disorder which may lead to a learning disability be diagnosed and corrective intervention be prescribed as early as possible. It is now known that the best time to learn foreign languages, mathematics, music, and other subjects is between the ages of 1 and about 12. Kotulak, R., xe2x80x9cInside the Brain,xe2x80x9d Andrews, McMeel Publishing, 1997. Therefore, the failure to promptly intervene may result in the therapy occurring beyond the prime developmental years for the brain.
Because of the interrelated nature and multiple potential causes of various learning disorders, present therapeutic techniques are designed to deal with surface behavior; namely, the symptoms of the underlying causes. It is widely accepted that current diagnostic techniques are incapable of sorting out the various disorders and their underlying causes. As a result, the prescription of corrective interventions is based upon trial and error which is inadequate given the short time span of the peak developmental period of the brain.
An important relationship between attention and aspects of motor regulation including inhibition, speed, rhythm, coordination and overflow has been postulated by several investigators (Barkley, R. A.; DuPaul, G. J. et al. (1990); Denckla, M. B.; Rudel, R. et al. (1985); and Piek, J. P. et al. (1999)). Gillberg, C. (1988) has described a group of children with deficits in attention, motor control, and perception termed xe2x80x9cDAMP syndromexe2x80x9d in a recent study, and found considerable overlap between attention deficits and motor clumsiness (Kadesjo, B. and Gillberg, C. (1998)). Piek, J. P. (1999) has recently demonstrated that severity of inattentive symptomatology in ADHD boys is a significant predicator of motor coordination difficulties. However, there has been no practical tool proposed to assist in the diagnosis of disorders on the basis of measuring the timing of the individual. Physiological tests are subjective and, therefore, depend upon the skill and condition of the test taker at any particular time. Some tests are capable of directly measuring neurological disorders, such as MRI examinations. However, such MRI examinations are intrusive in that they require that a particular dye be injected into the bloodstream as part of the examination process.
A neurological conflict diagnostic apparatus according to the invention includes a timing assessment tool. The timing assessment tool is manipulatable by a user and develops a timing score. A processor processes the timing score to a diagnosis and/or corrective intervention, or therapy. This may be accomplished by the processor applying the score from the timing assessment tool to a database and retrieving a diagnosis, a therapeutic intervention, or both from the database.
The use of a timing assessment tool eliminates the subjectivity that is present in other clinical rated timing assessments. Furthermore, because the timing assessment tool is manipulated by a user, the timing assessment tool is capable of assessing neurological functions which correlate with outward symptoms rather than measuring outward symptoms alone. Because the database relates timing scores with diagnosis and therapeutic interventions with various diagnoses, the inclusion of a large sampling of users in a database and performing of statistical analysis on the population allows a direct correlation between timing scores and therapeutic interventions without the necessity for establishing a known diagnosis.
According to another aspect of the invention, a diagnostic apparatus includes at least one user operable trigger, a control, and a database. The control generates a reference signal having occurrences separated by a predetermined time interval and determines a temporal relationship between user manipulation of the trigger and occurrences of the reference signal. A database includes a plurality of such temporal relationships and a diagnosis, a therapeutic intervention, or both for the temporal relationships. Preferably, the diagnosis apparatus includes a plurality of triggers that are operable by different user limbs. The timing assessment tool may be used to develop a timing score based upon a comparison of user manipulation of the different triggers. The reference signal may be either a non-speech tone or a series of different speech phonetic sounds in order to diagnose different disorders.
A method of determining a therapeutic intervention for a person having a neurological conflict according to another aspect of the invention includes providing a database of therapeutic interventions and timing parameters. The method further includes objectively measuring the timing parameter of the person and applying the measured timing parameter to the database and retrieving at least a therapeutic intervention from the database. The objectively measured timing of the person may include measuring any one of the person""s response time, response variability, break-in response sequence, out-of-phase responses, interactive responses, early responses, late responses, and any combination of such responses.
The present invention may obviate the need for conventional psychological testing, with its present subjective evaluations, and the necessity for identifying any one particular diagnosis. Instead, the present invention provides the capability for directly correlating timing parameters indicative of neurological conflict in order to establish a therapeutic intervention specific to the neurological conflict.
The present invention is intended to provide a tool for diagnosing and prescribing therapeutic intervention especially for learning disabilities but may be useful for other neurological conflicts such as Parkinson""s disease, Alzheimer""s disease, and the like. The invention is especially useful in improving the attention, motor and perceptual motor functioning, cognitive and academic performance, and control of aggression in children with significant attentional problems.